Provider Demographics
NPI:1548280688
Name:GARRETT, ROBERT BRUCE (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRUCE
Last Name:GARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 495156
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5156
Mailing Address - Country:US
Mailing Address - Phone:941-629-4500
Mailing Address - Fax:941-629-4171
Practice Address - Street 1:2300 LOVELAND BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-5716
Practice Address - Country:US
Practice Address - Phone:941-629-4500
Practice Address - Fax:941-629-4171
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0043075207RC0000X
FLME0043075207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
08128OtherBLUE SHIELD
5573046OtherAETNA
FL046539900Medicaid
060012031OtherRAILROAD MEDICARE
592171328-002OtherCHAMPUS/TRICARE
2101031OtherGHI
6583528002OtherCIGNA
283368OtherWELLCARE
08128OtherBLUE SHIELD
6583528002OtherCIGNA